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Do I *Really* Need a Birth Doula?

Dr. Olivia Chubey, ND

Yes!

And no. And Maybe.

It depends. On a lot of factors. Let’s break this down in an easy way. Take a few minutes and ask yourself the following questions:


  1. What is important to you in your birth experience?
  2. Do you have a birth companion?
  3. What kind of support do you expect from your birth companion?
  4. Are they capable of giving your that support?
  5. Do they have the tools and knowledge to support you?

If you answered YES to #2 but NO to #4 and #5.  

You *might* be able to get away without a doula if you take a prenatal class that focuses on educating you and your birth companion on coping techniques, how to use them in labour, and common interventions – for example our Confident Birth Program.  You may find that your birth companion may be enough, armed with the information they have learned to help you with your answer in #1. 

If you answered YES to #2, #4, #5 you may decide to still work with a doula for one of the following reasons: 

  • I understand that my labour may be longer, and I value the idea of my partner being able to rest so that they may help me more after baby is born. 
  • My partner feels anxiety regarding whether they can be whatever I need them to be/remember it all etc, so it would be good to have knowledgeable and comforting help in addition. 

(*Research has shown that the most positive birth experiences for fathers were ones where they had continuous support by a doula or a midwife.)

  • I know that statistics show that moms have better birth experiences and less medical interventions when a doula is present

(*Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons.)

  • I desire a low-intervention and/or no-intervention labour and understand the skill set and assistance a birth doula provides can support those goals even further then I can alone, or solely with my birth companion. 
  • I experience anxiety with hospitals, medical equipment, etc.
  • I understand a birth doula may have other areas of help and support that they can share with me to smooth my transition into parenthood. (For example, Lactation Support)
  • I feel birth is more than just a biological event, and would like to work with someone who treats it more holistically. 

If you answered NO to #2, I would highly recommend a doula. 

If this has piqued your interest or you’d like some more questions answered, you can book a complimentary Meet & Greet with a doula from our collective today! We’ll spend about 15 minutes with you in a video chat to answer you personal questions and help you decide if we’re the right match to support you in your birth!

Dr. Olivia Chubey, ND

*Evidence Based Birth, “Evidence on: Doulas”, May 4, 2010, Rebecca Dekker, PhD, RN.

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Alternative Options to Pain Medications

To epidural or not to epidural… is that even the important question? 

Dr. Olivia Chubey, ND

Do you want an epidural?

Great!

Do you want to labour and birth without an epidural?

Great!

Do you want to wait as long as possible before getting one?  Or, get it as soon as possible?  

Regardless of your personal preferences or medical necessities, in every circumstance – the real question is ‘can I cope with this’? 

Cope with discomfort, with pain, with the pressure of being a parent, doing the right thing for me – for baby…and the list of things goes on and on….   

The birth of your baby and the labour process, is a complex, enigmatic, beautiful collision of science, faith, luck, love and transformation.  But when discussed in modern science – it is usually reduced to pain. (If I were to extrapolate further, the entire birth experience often is reduced to: whether you will tear, what gender you are having/do you have a name, and whether you will breastfeed)

And I get that.  Pain is scary.  We are also wired to want to avoid pain, just like birth – it’s human nature, so it’s no wonder it’s become such a focus of our energy.

So whether or not you want, or need, the epidural, there are so many techniques/ways of being that can help get you more comfortable and able to cope – so that birth can be more than just about the pain.

Here is a quick breakdown of some of them

  1. Breathing Techniques
  2. Visualization techniques 
  3. Relaxation techniques
  4. Using hand on manual therapies
  5. Positions
  6. Water
  7. Music 
  8. Affirmations 
  9. Education – understanding your body and also the hospital interventions
  10. An active birth companion [partner doula or otherwise] and supportive healthcare team

I want you to know these and how to use them. 

I am deeply passionate about sharing the education, training and experience that I have with you. I want to support you through one of your most vulnerable experiences. 

My hope, by doing so, is to further reduce the statistic of you calling your birth a ‘traumatic experience.’ 

Connect with me, or anyone on our team – we are all just as passionate about this!

We can talk about what your needs are and suggest what course of action we recommend based on your unique needs. 

Or, if you just want to learn these techniques – click here to learn more about our Confident Birth Program or email info@yourdowntowndoula.com!

Dr. Olivia Chubey, ND

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You *just know* how to parent!

Dr. Kim Abog, ND

Have you ever had a strong hunch about something and it turned out to be true? Have you ever defied that little voice in your head (much to their dismay) and felt regret about it? 

As a parent, you may have already had several introductions, friendly or rude, with your parental gut instinct

“How to Trust Your Intuition”

Planning for parenthood can feel overwhelming.

When people become parents, they may naturally become open to learning about different aspects of parenthood and childcare to brace themselves for raising children. Many seek counsel from books, families and friends, classes, websites, and doctors and specialists. 

While the above traditional methods can help to sharpen child-rearing acuity, they may not be enough to prepare you for the imperfect mess of parenthood. Yes, that part of parenthood where everything you’ve read, seen, heard, or learned gets thrown out the window and seems to contradict what your child needs. That is because there is simply no way (yet!) to pass on instinctual information and intuition.

“Something feels wrong.” You’re probably right.

Your gut instinct, also known as gut feelings or intuition, is your natural ability that helps you decide what to do or how to act without thinking. Gut feelings are thought to be signals communicated between your brain to and from your digestive tract. Some experts also postulate that emotions play a key role in decision-making (naming gut instincts as somatic markers). 

There is still a lot to learn about the engrossing overlaps between the worlds of psychology, neurobiology, and gastroenterology. One thing experts generally agree on is how parents (research-wise, mothers in particular) can be more sensitive or susceptible to particular cues and signals from their children. 

Science has not fully caught on with Nature’s Human Parent Design yet but we are seeing some fascinating evidence of intuition in action. 

The Pregnancy Brain 

Mom, your brain will adapt!

A 2017 study has shown that pregnancy causes substantial changes in brain structure, primarily reductions in gray matter volume. Gray matter loss is not necessarily a bad thing in pregnancy, because the volume reductions occurred in regions that enable us to read social cues (ie. reading baby’s behavior intuitively). These same regions had the strongest response when mothers looked at photos of their infants. Gray matter loss was only seen in (new) mothers but not in fathers. It’s not clear why women lose gray matter during pregnancy but this may be evidence that brain remodeling may play a role in helping women transition into motherhood and respond to the needs of their babies. These reductions lasted for at least 2 years postpartum.

New Parent: trust your gut!

The Sixth? Seventh? Eighth? Sense

There are also some studies that have noted the significant value of using solely the parent’s recognition of baby’s cries, touch, and/or concern in proceeding with the management of fevers and ear infections. Generally speaking, parental concerns may be more useful to exclude the possibility of health issues than “rule in”. These global findings also amplify the need for care practitioners and advocates to promote and prioritize parental well-being in health practice in order to strengthen parental intuition

You just know.

Parents: You’ve got this!

Parenthood is a steep learning curve, and one that you’ll be on for an indefinite amount of time. You will always be a parent. You just become more comfortable with the uncertainty. Getting comfortable means trusting and believing in yourself enough to know that you are capable of taking care of and advocating for your family. It is also in knowing that there is no one right way to do so. You got this; you always have. 


Dr. Kim Abog, ND

 

Sources

https://pubmed.ncbi.nlm.nih.gov/23591865/

https://www.ncbi.nlm.nih.gov/books/NBK75333/

https://www.racgp.org.au/afp/2012/september/a-is-for-aphorism

Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.

  • What tests and screenings will be offered and when
  • When to sign up for prenatal education and what types to consider
  • Things you should think about that your care provider may not mention
  • Links to helpful resources

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Considering a VBAC*? You Need to Read This!

Dr. Ee Von Ling, ND

*There is a shift towards using the term TOLAC (Trial of labour after C-section) instead of VBAC (Vaginal Birth after C-section). In many ways this term is preferred, less emotionally loaded and less cumbersome than using VBAC. Thus, I will be using both VBAC and TOLAC interchangeably in this post. 

One of the very first births I attended as a new doula was a home VBAC. The parents had taken my HypnoBirthing classes and requested me to be their doula. At the time I was just so excited to be going to a home birth that I didn’t even think about the significance of this being a TOLAC.

The mother told me her birth history and the events that had led up to her c-section – “failure to progress at 9cm”. I took all her info and simply reassured her, “every pregnancy is different and so this will be a different experience than your first one”. And it was different. Amazingly different. The labour and birth progressed just like any other normal labour and birth and the mother had her successful home VBAC!

This VBAC homebirth imprinted on me that VBACs were no big deal and they were just like any other birth.

It wasn’t until I started having more conversations with pregnant clients and doctors and reading comments in mommy forums and news articles that I would realize that VBAC’s were seen as A. BIG. DEAL. Words like “highly risky”, “uterine rupture”, “endangering baby”, “dangerous for mom”, “irresponsible” almost always accompanied the VBAC discussion. It was bad enough that women had fear of normal labour and birth itself, but having a past c-section somehow put a whole other layer of fear and worry on top of that.

So I double checked the evidence and the statistics around VBAC and risks and benefits.  Contrary to the conversations, the numbers showed that a vaginal birth after a previous c-section was a reasonably safe and healthy choice for most women. The absolute risks were very low and the success rates for attempted VBACs were actually quite high. In fact, the risks for a planned repeat c-section were worse. If you’d like to learn more about the pros, cons and risks around attempting a VBAC, you can read this very excellent handout created by the Ontario Association of Midwives here.

Over the last several decades VBAC rates have gone up and down. According to US statistics, In the 1990’s about 30% of those who had a previous C-section attempted a VBAC. Today that number is about 13%. These numbers have fluctuated because of changes in the practice guidelines of obstetricians. VBAC births themselves did not become more dangerous, but practice guideline updates recommended more medical requirements in order to offer them. These changes influenced the perception and accessibility of attempting VBACs – OB’s became less supportive of them and the public developed a bigger fear of them. Understand that the risks and outcomes for those who attempt VBACs did not change in the last 40 years. 

Being able to go through a trial of labour after C-section might be a very significant and impactful choice. For some, being able to vaginally birth helps them to heal a previous birth trauma and reclaim the birth experience for themselves. As a medical industry, we should not take the personal decision to try for a VBAC lightly and we should provide unbiased information and support for that person. 


If you had a previous C-section and are now considering a VBAC for your next childbirth, here are 6 things you can do to help improve your chances of birthing your baby vaginally: 

  1. Choose a supportive provider: This might be the most important factor of all. Having a midwife improves your chances of giving birth vaginally and with fewer restrictions around VBAC. If you are not able to get a midwife, make sure your OB is VBAC supportive. How will you know if they are VBAC supportive, ask them outright: 

  • Are you supportive of VBAC?
  • What is this hospital’s TOLAC rate? How many of your own patients chose TOLAC and how many of those result in VBAC?
  • What would be your advice around increasing my chances of achieving a VBAC?

You will get a sense of their own attitudes and biases based on how they respond to these questions. 

  1. Learn techniques so you can labour at home for as long as possible: Choose a program that includes learning and practicing breathing exercises, visualizing, releasing past fears. Our clients who have been able to VBAC took HypnoBirthing classes, listened to positive birth podcasts, read books about empowered birth by Ina May Gaskin and Penny Simkin. From our own collective experience supporting our own VBAC clients, we teach a special condensed version of our  Confident Birth Prenatal Program that focuses just on the relaxation exercises and techniques to help you be calm and confident during labour.  

  1. Ensure the baby is in a good position: Head down is not enough!  Baby’s position with their back on the left side so you feel kicks or the big movements on the right (referred to as LOT) or baby’s back is in the front so you don’t feel a lot of kicks or movement elsewhere (referred to as OA) are the ideal starting positions for baby. A baby in the posterior position (or OP or “sunny side up”) may have a harder time being born vaginally. Perhaps during your previous birthing the baby was in this posterior position, which can lead to slow or arrested labour. 

There are ways to help encourage a baby to get into the ideal starting position for birth. Daily positional awareness, acupuncture, massage, chiropractic, osteopath and physiotherapy treatments may help. 

  1. Get your labour to start naturally: If you labour starts naturally, this will help you avoid further interventions that might increase the risks of a TOLAC. Speak with your midwife or doula about ways to start labour that are safe for those who’ve had a previous c-section.

  1. Try to avoid an epidural: An epidural can limit movement and slow down labour (if started early in labour). If labour slows down, then artificial oxytocin will be needed to help progress the labour. But using artificial oxytocin in someone who had a C-section increases the risk of having a VBAC (ie. scar separation). This is why learning good coping techniques and having a doula can be very helpful. That said, if you need an epidural to help you have a positive birth experience, then by all means, choose that for yourself! 

  1. If you have an epidural, use a peanut ball: Even if someone has an epidural, there are tips and tricks to help increase your chance of a vaginal birth. A peanut-ball is a peanut shaped exercise ball that can be used in a variety of positions to help open up the pelvis and positively influence the positioning of the baby as it’s being born. 


Beware the “VBAC calculator”! Recently, I have been hearing about care providers using a “VBAC calculator”. Different factors about the pregnant person are inputted into an algorithm that is supposed to predict the percent chance of having a vaginal birth. The use of this is a HUGE RED FLAG to me, and if this becomes part of routine OB and midwifery practice I fear that VBAC rates will decrease even further. 

What is wrong with these calculators? 

First, the database of information that these calculators use is from observational data of a specific patient population. The one that care providers in Toronto have been known to use is from a patient population in the United States. American birthing patients and American birth management practices are very different from the birthing patients and birth management practices in Canada. VBAC rates in the US are much lower than VBAC rates in Canada. A hospital with low VBAC rates will produce patients with low VBAC rates and vice versa. So you can already see a discrepancy in applying such a calculator on a random patient. 

These calculators are not evidence based, meaning no study has been done to test the impact of using these calculators to accurately predict actual VBAC success, we also need to study how these calculators impact decision making in both the OB and the patient. 

We are well aware that there is bias in the practice of obstetric medicine, meaning, if a care provider is personally biased in the management of a particular patient, it greatly influences the outcome for that patient. For example, if this VBAC calculator happens to calculate a low success rate, then that can influence the OB to assume that the patient’s attempted VBAC will end up in a c-section. 

Here is a link to an article that explains the research that critiques the use of VBAC calculators.

In any case, the American College of Obstetricians and Gynecologists had this to say about VBAC calculators: “… population-based statistics cannot accurately predict an individual’s VBAC success odds….It is ill-advised to use statistics as a primary indicator when making VBAC decisions.

The role of a doula in your plan to have a TOLAC: The good news is, a doula can navigate at least 5 out of 6 of the positive factors listed. Having the presence of continuous and on-going support from a doula is supported by research to help you avoid a c-section (whether it’s your first childbirth or an attempt at a VBAC). If you are interested in learning more about how a doula could be an integral part of your VBAC team, book a free meet and greet with us today!   

Dr. Ee Von Ling, ND

Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.

  • What tests and screenings will be offered and when
  • When to sign up for prenatal education and what types to consider
  • Things you should think about that your care provider may not mention
  • Links to helpful resources

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Things Your Care Provider Can’t Predict

by Dr. Ee Von Ling, ND

Care providers of pregnant people (OB, midwife, nurse and MD) seem to take pride in somehow being able to predict the future of your labour and childbirth. Do they have a special sense or skill set to be able to do this? 

No.  

They are regular humans just like you and me and they are NOT able to predict very much, if anything at all. But they will have you believe that they can. 

Here is a list of the most common things that your pregnancy care provider may try to predict but they cannot possibly know the absolute future: 

  1. When your labour will start. There is no way to know when your labour will start. Not by the size of your pregnant belly. Not if this is your first or second or 5th pregnancy. Not even if they check your cervix at 40 weeks (if you are still pregnant). And yet, we will hear of care providers telling clients that they will have their baby early or go past their due date purely on a personal hunch. 

Did you know that medicine and science don’t really understand how labour spontaneously starts? This always blows my mind because we certainly have many methods of artificially starting labour. We just don’t know the exact mechanism that causes your body to start its own labour. We do have some understanding that the baby influences the start of labour, and this makes sense. When your baby is mature enough to survive and thrive outside, their body secretes proteins from their lungs and brain that can eventually make their way into your blood circulatory system and to your brain. In the brain these signals received from the baby trigger the production of different hormones that prepare and perhaps trigger the body to start labour.  

Around your due date, your care provider may offer to check your cervix. This check is optional and only gives us a snapshot of what is going on with your pregnancy at that moment. Even if your cervix has changed and is showing signs of getting ready (getting soft, moving from posterior to anterior position, starting to dilate by 1 or 2 cm), we can’t tell when labour will start. Even if your baby is low in your pelvis, there is no way to predict when labour will start. 

There is no way to predict when labour will start if this is your first pregnancy or subsequent. Many people hear that first babies come late, and statistically this is somewhat true. According to the US childbirth data available, by 5 days after the due date, 50% of babies of first time parents will be born, and the other 50% are born after this time. What about subsequent babies? By 3 days after the due date, 50% of subsequent babies are born and the rest are born after this time. 

What does this mean? We are born procrastinators (you may groan now). 

There is no way to predict when labour will start according to family history or within the birthin history of the same person. Each pregnancy is different, and this includes when labour will start. That said, research has been able to find some factors that may increase the chance of preterm labour. Some of those factors are genetic and some of those factors are environmental (for example nutrient deficiencies, illnesses, smoking, drinking alcohol or doing drugs while pregnant). 

It may seem harmless to tell a pregnant person that their baby will come early or late. But for that person, such baseless comments can cause unnecessary stress or even cause that person to make pregnancy or childbirth-based decisions that may not be healthy and are certainly not warranted. 

  1. The size of your baby. The only way to get an accurate assessment of your baby’s weight is to weigh the baby after they are born. There is no accurate way to know the exact size of your baby before that. Not by the size of your belly. Not by the amount of weight you have gained. Not by ultrasound assessment.

It is pretty common, although not actually considered a standard part of prenatal care, to be told to get a 3rd trimester ultrasound. The main reasons are to assess the growth of the baby (read: size), amniotic fluid levels and general health of the placenta. Parents will be told, “Your baby is 1234 g”. The care provider might run with this info and say “based on this, your baby will be 4567g at birth. That will be a big baby! You will likely need a c-section”. Then they turn around and leave the room, leaving the pregnant person VERY DISTRAUGHT. 

There is a lot to undo here. First, ultrasound weight measurements are very inaccurate, with at least a 15% margin of error. The inaccuracy of ultrasound to measure weight WORSENS as you get closer to the due date, by at least 20% margin of error. There is no other professional industry that would accept such a high margin of error. Could you imagine if an engineer used tools with such a high margin of error? “I think this bridge will be 50 metres long, give or take 10 metres”. Or if your pharmacist said, “The dose of this medication is 100mg give or take 20 mg”.  Even with acknowledging the margin of error, it is very hard for parents to “unhear” that they may have a large baby. Thinking that a baby is going to be a certain size most definitely influences medical decisions around early induction and choosing c-section.I have had clients choose a c-section based on “big baby” predictions, only to find out the baby was a very average 7-8 pounds. 

Growth in pregnancy is not linear. This means that a snapshot of what is happening now cannot predict what will happen in the future. Weight gain often happens unevenly throughout pregnancy. You or the baby might gain most of your weight during 1 trimester and not as much the next trimester. As long as the placenta is healthy, some babies might be 80 or 90 percentile for weight during much of the pregnancy (according to ultrasounds) and then end up being 50% for their birth weight (real life weight).  

Let’s also not underestimate the amazingness that is your body. I have attended births where the parent vaginally birthed (and often without an epidural), 9, 10 and almost 11 pound babies. We just had no idea of the baby’s weight and just focused on her being able to birth her baby. 

Don’t get me wrong, ultrasounds can be a useful tool to track trends in a pregnancy. We can track over a series of ultrasounds that a baby is growing well, or not well, or is trending on the upper end of the weight charts. We cannot make such a guess based on just one ultrasound picture. Even so, there will still be surprises at birth. No technology that currently exists is perfect. 

Ultrasounds aside, any other comments on a person’s weight related to baby’s size should stop as there is no relationship between the two. In fact, let’s just stop comments on the size of people’s pregnant bodies altogether.  

  1. How long labour will last or how it will progress. When labour starts, your miraculous body is working to eventually accomplish a few things: a) Softening and thinning out the cervix from the firmness of your nose to the stretchiness of a piece of very thin spandex material; b) Drawing open the cervix so that it is fully dilated and “gone; c) shifting the muscles towards the top of the uterus so that they can better move the baby down into the vagina; d) Moving the baby around the pubic born to e) emerge and be born out the opening of the vagina.

There is absolutely no way to accurately predict how long any of these stages will take. Checking the cervix and the station of the baby (how far down they are in relation to a specific point in the pelvis) are a couple of the ways to assess how the labour is progressing. The softening of the cervix (step a) is expressed as a percent with 100% being completely soft and stretchy like a piece of spandex. It takes a lot of work for this to happen and it needs to happen in order for the cervix to open fully. Sometimes the cervix effaces completely first and then the cervix starts to dilate. So if the cervix is only minimally dilated (say only 1 or 2 cm) but it is 100% effaced, that is still a very good sign because the cervix can easily and sometimes quickly dilate to 10cm. 

Other times, the cervix softens a little then dilates a little, then softens a little more and so on. So when checked, the cervix may be 4cm (yay!) dilated but 50% effaced (still good, but more work and time may be needed for the cervix to become completely effaced and dilated). 

There are also those times when me and the birthing team are completely surprised when all of a sudden the parent goes from 5 cm to fully dilated within an hour. 

And while the cervix is changing, the baby is moving downward. The system of assessing this movement is called “stations”. Zero stations means the baby’s head is aligned with a bony landmark within the pelvic called the ischial spines (or simply “spines”). If the baby is higher than this, a negative number is used, like -1 or -2. If the baby is lower than this, it means the baby is descending into the vagina and positive numbers are used + 1, +2 and so on to +5 being the baby’s head is about to be born. In a textbook labour, when the cervix is fully dilated, the baby is at zero station. In real life the cervix can be dilated and the baby is at -2 station (still high), or the cervix can be just 5 cm dilated and the baby is at zero station (quite low). 

All this information just illustrates that there are too many factors in play to be able to predict or dictate how fast a labour should progress. Unfortunately a long held “formula” (called Friedman’s curve) is often quoted: “We expect your cervix to dilate 1 cm every hour.” This rate was created by a Dr. Friedman based on his observation of 500 births in first time labouring women aged 20 – 30 years old in the 1950’s. He was the first to put a timeline on labour and his observed rate of dilation in his limited population of study has been used as a guideline ever since. As you can imagine things have greatly changed since the 1950’s and this very limited view of labour can no longer be applied. To read a full and thorough critique of using Friedman’s curve you can read this article by Evidence Based Birth.

The main point here is that there is a huge range of how long a labour may last. As long as the birthing parent and baby are doing OK and as long as there are signs of labour progressing (cervix is changing, baby is descending), then we just need to afford you the time to allow your body work and make childbirth happen. 

Dr. Ee Von Ling, ND
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Choosing the Best Bottle for Baby

Dr. Sarah Winward, ND

Choosing a bottle can be confusing, especially if you’re planning on primarily breastfeeding/ chestfeeding. You’ve probably heard about nipple confusion or bottle preference and, rightfully, you’re a bit worried about this happening to you! 

As an IBCLC, I regularly support families who use bottles some or all of the time. Here are my tips on what to look for when choosing a bottle for your baby:


  1. Is it comfortable for you to hold?

This has nothing to do with baby, but if you’re planning on using bottles regularly, it needs to be comfortable. Some of the bottles on the market that are designed to “mimic” breasts are not remotely ergonomic. I recommend holding a few of different sizes to see what feels best for you.


  1. The nipple should be long with a wide base, not “nubby”.

These are the 2 general shapes you’ll see for both bottle nipples and pacifiers. A “nubby” nipple often encourages babies to have a very shallow latch, because their mouths rest comfortably around the nub and their lips end up on the smallest part. You want your baby to have a wide open mouth to avoid pain with nursing, these types of bottles are not doing you any favours. Try to find a nipple that is longer with a wide base. When you’re bottle feeding make sure your baby’s mouth is fully down around the base of the nipple so their mouth is wide open.


  1. Look for a slow flow nipple.

Bottle preference generally happens because bottles have very fast flow. While bodyfeeding, you have to ask for the milk to flow in order to get it going. If you tip a bottle upside down milk will drip out the nipple. When a slower flow nipple, you get less of that dripping because the hole is smaller. That means it’s going to be less overwhelming for baby if you do tip it up and it means that baby has to work to get the milk moving. 


The biggest thing to remember is that HOW YOU FEED YOUR BABY MATTERS THE MOST. Paced bottle feeding is a bottle feeding technique that mimics the flow of milk from the breast. We have an article on how to pace a bottle, including a video here.

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Paced Bottle Feeding

What is paced bottle feeding and why should you care? 

As a breastfeeding advocate, I am very much in favor of babies breastfeeding anywhere and all the time. But, it would be naive of me to think that this is realistic for every breastfeeding dyad. Lots of families choose to bottle feed some of the time and breastfeed other times. How you breastfeed a bottle fed baby matters, though. It's all too common that I see families soon after they've introduced a bottle because their baby has started becoming fussy at the breast or is refusing to breastfeed altogether. This is where paced bottle feeding comes in.

Paced bottle feeding is a technique that allows the baby to have much more control over the flow of the feed, and also mimics the flow of milk from the breast alot better. Babies don't get nipple confusion- they get flow preference. If you tip a bottle upside down you'll notice that milk starts to drip out, bottles are fast and consistent. Milk flow from the breast ebbs and flows depending on whether you're having a letdown or not. In fact, for parts of a breastfeed babies are getting no milk at all. Babies are smart and often develop a preference for the easier and faster flowing bottle.

Benefits of Paced Bottle Feeding

  • Baby has contol over how much they eat, so you aren't at risk of over feeding or under feeding them
  • Less chance of overfeeding often leads to less fussy babies because they aren't uncomfortable from having a distended stomach
  • Easier time going back and forth from breast to bottle
  • Although this has not been studied, because baby is controlling their intake this should help preserve the mechanisms in breastfeeding that prevent obesity and type 2 diabetes later in life

Are you planning on breastfeeding? Get started out right with our Free Breastfeeding Basics Guide. Grab it here!

How to do it

Check out the video below for a how to guide on paced bottle feeding.

Key points

  • Start the feeding with baby sucking on an empty nipple for a few seconds, this is expecially important if you've noticed your baby starting to get fussy at the breast
  • Keep the nipple 50% full of milk so that they baby can access it by sucking but it doesn't just pour into their mouths
  • Give your baby periodic breaks when you tip the bottle down so there is no milk available
  • You'll know it's going well if you see your baby taking pauses where they aren't sucking at all
  • Let your baby tell you when they are done and don't force them to finish what is in the bottle
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What disservice do we do to women?

Dr. Olivia Chubey, ND

Think about the last movie you saw that featured someone giving birth. I’m guessing there was a woman screaming, a man freaking out, and a doctor yelling “Push, push push!” 

Katherine Heigl in ‘Knocked Up’

Now tell me how many of your friends are terrified by the thought of giving birth? Maybe you’re included in that group!

Popular culture does a really good job propagating the culture of fear around birth. 

And that translates into our everyday lives. 

You hear negativity about birth all the time. Even friends who haven’t had kids say things like “oh, you’ll be screaming for the meds” or “are you ready for your body to be destroyed”. 

I remember in my first maternal and newborn care class, so many of my friends whispered to each other during lecture about how scared they were.

I was scared too – how could I block out all that negativity?

But those lectures taught us about physiology. About how pregnancy is not a medical condition, it’s normal. 

This drove me to look further, to learn more.

So, I dove head first into the birth world. Reading books, articles, watching videos. This led me to a doula training. Everything confirmed what I learned in those first lectures.  

Birth doesn’t have to be scary. It doesn’t even have to be painful! 

My education and understanding of physiology took away my fear. 

It also got me incredibly excited! I NEEDED to learn how to help parents achieve empowering birth experiences.

This lead me to HypnoBirthing. This training taught me techniques that help parents remain calm and relaxed. Techniques that work WITH our physiology, to facilitate empowering birth regardless of circumstances. 

How we view things matters. 

So, that crazy pop culture birth scenario doesn’t have to be my experience. It doesn’t have to be anyone’s experience. 

The more I go to births, the more I see how beautiful these moments could be. Labour can be a sacred space. Parents can connect with each other and welcome their babies into warm, nurturing environments. 

All of these experiences have completely change my outlook about birth. Now, I look forward to becoming a mother and naturally birthing my baby. There is no more fear.

Dr. Olivia Chubey, ND

Resources for a Calm & Confident Birth

Confident Birth Prenatal Class

Hypnobirthing Classes

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Perineum Discussion Part 2: Besting Your Chances for Minimal Injury

Dr. Ee Von Ling, ND

Dr. Ee Von Ling, ND

Trigger warning: Discussion about vaginal birth and perineum. Discussion about perineal injury and tears. 

This post will go right into the discussion of how to reduce perineal tears and injury. To learn about the 4 different types of perineal injury and read my personal account of having a 2nd degree perineal injury, first read My Childbirth Experience

Is there anything you can do to help reduce perineal injury? 

YES!

The most important factor that influences your risk of a perineal injury will surprise you. 

Your care provider is one of the strongest factors of having an intact perineum: 

Having a homebirth with a midwife is the best way to help avoid a perineal injury. Second to this is having a birth centre birth with a midwife. The main reason is episiotomies and repairing a 3rd or 4th degree perineal tear are not within a midwives’ scope of practice, so they are skilled in helping birthing people avoid or minimize these injuries. 

Having an OB with a high 3rd or 4th degree perineal injury rate or has a high rate of episiotomy use will have the highest risk of developing a perineal injury. 

If you want to give birth in a hospital, get a midwife to help reduce your chance of a perineal injury. 

If you don’t have access to a midwife, ask your OB what their 3rd and 4th degree rate is (it should be 3% or less, if it is much more, it means they are not taking preventative measures). Ask  your OB how often they are doing episiotomy, or under what circumstance they are doing this. Fortunately, hospitals in the GTA have a no routine episiotomy policy, meaning, the OB should not be doing them as just a matter of routine.  Ask your care provider if they obtain consent from the client first if they are considering to do an episiotomy

Other tips to help reduce severe (3rd and 4th degree) perineal tearing: 

  • Be in an upright birth position (If you have no epidural)
  • Be in a side lying birth position with delayed pushing (If you have an epidural)
  • Warm compress against the perineum (Done by your care provider – this helps reduce severe tears and reduce pain)
  • Perineal massage by the care provider might help lower your risk of a severe perineal  trauma, increase your chance of having an intact perineum, or it might make no difference (They need your consent first!)

These other factors that can increase your risk: (Unfortunately, these factors are less under your control)

  • Size of baby (the bigger the baby, the bigger the risk)
  • Position of baby at birth (if baby is “sunny side up”, OP or face up at birth)
  • Very long or very short 2nd stage (pushing time)
  • Shoulder dystocia (difficulty with birthing the shoulders)
  • Use of forceps or vacuum
  • Family history of severe perineal tears

Among the research, there was a particular group of midwives with an amazing 73% intact rate! What did these expert midwives do differently?  

  • They performed slow, calm and controlled delivery of the baby’s head
  • They guided with non-valsalva pushing
  • They delivered the baby’s head between contractions

Additional tips from these expert midwives: 

  • When the baby is crowning, they warn clients to blow instead of push
  • Avoid coaching to push
  • Avoid pushing during crowning
  • Encourage hands and knees position
  • Allow the baby’s head to remain on the perineum for a number of contractions
  • Wait until baby has rotated before trying to birth shoulders

What about doing perineal massage? 

Studies conducted have shown that doing a minimal amount of perineal massage (1-2 times/week, 10 minutes each time, starting from 34 weeks of pregnancy) can help reduce the chance of perineal injury for people birthing for the first time. People who are birthing after the first time generally have a lower chance of perineal injury, and doing perineal massage has not shown to reduce the rate further. However, doing perineal massage has been shown to help reduce perineal pain from childbirth. Interestingly, there is no added benefit in doing more than the minimum amount. 

Also, no study showed that perineal massage made it worse for perineal health. Thus, I always recommend that you do some perineal massage to help prepare physically as well as mentally for childbirth (learn to relax and practice breathing exercises while doing it). 

Injury to the perineum is cited as one of the most common fears that people have about giving birth. The fear is strong enough to influence people to not have children. It is the unseen and unspoken part of birth.  We don’t properly educate the public on the ways that help reduce perineal trauma, leaving the power and decision making to the care provider. I hope that in sharing these evidence-based tips and my own personal experience that you feel more empowered to gain control of this part of the birthing experience. 

Links: 

Perineal massage video

Evidence Based Birth: Perineal Massage

Evidence Based Birth: top 5 tips on protecting the perineum

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My Childbirth Experience (Perineum Discussion Part 1)

Dr. EeVon Ling, ND

Dr. EeVon Ling, ND

*Trigger warning*: Discussion about vaginal birth and perineum. Discussion about perineal injury and tears. 

Injury to the perineum is cited as one of the most common fears that people have about giving birth. (I prefer to use the word “injury” rather than tear, as I feel “tear” in the context of childbirth can produce such a visceral response that can be disturbing for many people)

Ask any group of people of child-bearing capability “How many of you have felt frightened at the thought of tearing during childbirth for yourself or someone else?” Almost all will say yes. This fear is so impactful that it can influence the decision to not become pregnant at all.

So what is it really like to give birth vaginally?  What happens if you have a perineal injury? 

This is my account of what it’s like to vaginally birth and have a 2nd degree perineal injury. 

To give some background info, perineal injuries due to childbirth are divided into 4 categories, based on severity and tissue and organs that may be involved (It is not based on the number of stitches needed as many people believe): 

  • Intact perineum – no injury occurred
  • 1st degree – least severe, involves only the skin around the opening of the vagina. Depending on the nature of this, stitches may or may not be needed
  • 2nd degree – involves the muscles between the vagina and anus – usually needs stitches
  • 3rd degree – affects the muscles around the anus
  • 4th degree – the most severe, reaching the tissue lining of the rectum

3rd and 4th degree injuries require an OB to repair in the OR of a hospital (for example, if you have a midwife and a homebirth and a 3rd or 4th degree injury occurred, you would be transferred to the hospital and an OB would  be assigned to help you). 

Generally speaking, up to 80% of people birthing for the first time experience perineal injury. Of that number of people: 

1st and 2nd degree perineal injuries are most common

3rd and 4th degree occur in less than 10% of that number – when no preventative measures are taken. 

Upon digging into the research on this topic, I learned that there are a few factors and preventative measures that can help you significantly reduce your chance of having a perineal injury! If you want to go straight to the evidence, read Perineum Discussion Part 2: Besting Your Chances for Minimal Injury.

Back to my experiences. I had 2 wonderful home water births, about 2 years apart, with 2 very different perineal outcomes. 

First birth: “She flew out of me”

I woke up that morning with a sore back, causing me to curse the really long walk I did the day before. As the morning progressed, I realized it was labour starting. I had learned HypnoBirthing (YDD HypnoBirthing) in preparation for our planned home birth and the techniques helped me cope with the progressing labour. As we got into the evening, our midwife arrived, checked me and my baby and everything was healthy and going well. At some point I got into the birth pool and continued labouring there.  

As my labour really ramped up, the midwife asked me “Did your water break?”  I had been in the pool for a few hours at least and so I had no idea. The midwife suggested that she check my cervix, which I agreed to.  I got out of the pool and during the check it was discovered I was 8cm dilated but my water had not broken yet. Labour was really intense at this point and after having a short conversation, weighing my options (yes, you can still have a logical conversation weighing the pros and cons of an intervention in the thick of labour!), I agreed to have my water broken by the midwife (also referred to as “rupture of membranes”).  

Once that happened, things progressed extremely fast. My baby quickly descended and was crowning within just a few minutes. One moment I could just feel the tip of her head. The next moment I heard a “Floomph ” and I saw my husband and midwife fish our daughter out of the water and put her on my chest.  Our daughter literally flew out of me in 1 contraction. 

As a result I had a 2nd degree perineal injury. 

Because she was born so fast, I did not feel the commonly described “ring of fire” that many birthing parents report. Because she was born unexpectedly fast, my midwife didn’t have a chance to do anything to support my perineum. Would it have made a difference to my perineum had I not had my water broken (I believe that really sped up what was already a fairly fast labour)? Would it have made a difference if the midwife were able to actively support my perineum during crowning? I did perineal massage (link to perineal massage video), did that help reduce the severity of my injury? I’m not sure, but later I will discuss what can help in reducing perineal injury. 

My labour and birth were a great experience that I owe to having the birth pool and using the HypnoBirthing techniques. The repairing of my perineum? That SUCKED. 

For me, getting the stitches was the worst part of my birth experience. Why? During labour and birth I sort of knew what to expect based on what I learned in my naturopathic medical training and from the HypnoBirthing prenatal classes. I was sitting in a padded pool filled with warm water and listening to relaxation music and affirmations and breathing like a real pro. 

Getting the stitches, on the other hand, was quite the opposite of zen. I had to lay on my back on a bed. I was wet and cold (despite my husband’s best efforts to dry me off and our condo was an un-air conditioned 28 degrees in the middle of July). Before doing any stitches, the midwife injected local anesthetic. My perineum felt very raw and vulnerable and all the poking and sharpness of the repair process was harder for me to handle than the labour and birth. Luckily that part was very short, only a few minutes. I used my breathing exercises during that time. In hindsight, more distractions like music playing, having my husband close by (he was tending to the baby in a different room as the bedroom we used was very small) and having other coping measures available would have been very useful to reduce the intensity of that experience.  Would it have been helpful if someone disclosed the details of what it really feels like to get your perineum repaired (without an epidural)? I’m not sure, and I still grapple with this question when I teach HypnoBirthing Classes and our Confident Birth Prenatal Program to my parents. 

Recovering from a vaginal birth and 2nd degree perineal injury:  It took me about 2 weeks before I felt normal down there. It is very normal, and very alien-feeling, to have all that swelling and tenderness. A girlfriend, who gave birth a few months later and who has a very crass sense of humour, called it her “hamburger”.  

I didn’t pay much attention to my perineum before, but for the 2 weeks after birth I had 2 all-consuming jobs 1) feed the baby 2) look after my perineum.  I was quite diligent with the ice packs and sitz baths. I used 2 peri bottles filled with hot and cold water so I could do a mini hydrotherapy session each time I used the toilet. (I always remind my new parents to take the extra time to care for their perineum.) I think I spent those first couple of weeks horizontal as standing, walking and sitting made me really tired and caused my pelvis to feel heavy and dragging. It was helpful that I was sort of observing the Chinese tradition of “confinement”  – resting and staying indoors for 1 month after the baby is born. Meaning no going out to run errands or doing things that would further exhaust or deplete me. 

The stitches get itchy making you want to, but also don’t want to, scratch them. 

When your perineum starts to feel better, and you know you’ve rounded the corner on your recovery, it’s like the fog has lifted and you start to feel more like yourself. That said, please still take it slow as doing too much too fast can regress your recovery. After my perineum fully recovered, I did experience a bit of a lingering sensation. It wasn’t pain exactly, but a bit like a ‘pulling” sensation with sex and sometimes with peeing. I didn’t know much about pelvic floor physiotherapy at the time, although I wished I did and it’s something I recommend to my clients postpartum to help address any issues that remain after recovery from childbirth. 

Second Birth Experience: Much better

The birth of my second daughter about 2 years later was almost a rinse and repeat of my first experience. I say almost because I came away from it with an intact perineum (that and the labour was much faster).  What was different this time around? Experienced birthing parents do have a decreased risk of perineal injury  to begin with (almost 50% less chance), so the odds were in my favour. My second child was almost the same weight and size as my first, but the difference was the speed of her entry into the world. My midwives (different than the first) were very hands off and it wasn’t until my baby was crowning that they realized my water hadn’t broken yet! With the water intact maybe that helped slow down the crowning a bit.  Once they realized she was about to be born, they were able to guide me and my breathing so I didn’t push her out too fast and they provided perineal support. 

I did not have to go through the repair process. Thank goodness! 

Recovery from birth without a perineal injury is so much better (as you can imagine)! I felt like myself just days after giving birth. But there was still some swelling so I still made sure I took care of my perineum (a bigger challenge when you have a baby and another child). 

I feel pretty lucky that I didn’t have any lasting pain or incontinence issues after giving birth.  Unfortunately many people do develop chronic pain or some degree of incontinence after childbirth as a result of the perineal injury. Having serious perineal trauma can affect your recovery, your ability to care for yourself and your baby and can impact your mental health. Perineal injury can lead to problems with incontinence, pain with sex and chronic pain in general.  If there was some way to help avoid or at least reduce the severity of a perineal tear, we have a duty to inform those who are pregnant. 

Is there anything you can do to help reduce perineal injury? 

YES!

The most important factor that influences your risk of a perineal injury will surprise you. 

To learn more, read Perineum Discussion Part 2: Besting Your Chances for Minimal Injury